Vericiguat

Soluble guanylate cyclase (sGC) stimulators
Soluble guanylate cyclase (sGC) stimulators
Pregnancy: contraindicated
Contraindicated: it may harm the fetus; a negative pregnancy test is required before starting and reliable contraception during treatment and for a month after.

An oral sGC stimulator added to standard therapy in heart failure with reduced ejection fraction after a recent worsening, to cut deaths and admissions.

Updated Nov 1, 2026

Quick facts

Group: Soluble guanylate cyclase (sGC) stimulators
Target: Soluble guanylate cyclase (α1β1), the nitric oxide receptor
Used for: Symptomatic chronic heart failure
Key effects: Low blood pressure · Dizziness and lightheadedness
Monitor: Blood pressure · Haemoglobin
ATC: C01DX22

No doses: the clinician sets them by the current guideline.

Mechanism of action

Soluble guanylate cyclase (α1β1), the nitric oxide receptorVericiguat

The figure shows riociguat bound to human soluble guanylate cyclase; vericiguat is a close relative that binds the same stimulator site.

Target in 3D: Soluble guanylate cyclase (α1β1), the nitric oxide receptor. PDB structure 7D9R (RCSB PDB, public domain). View the structure at RCSB PDB

In heart failure, nitric oxide signalling and cGMP production are impaired, which contributes to stiff, constricted vessels and a struggling myocardium. Vericiguat stimulates soluble guanylate cyclase directly and sensitizes it to the body's own NO, like riociguat but with a longer half-life. More cGMP relaxes vascular smooth muscle and is thought to improve cardiac and vascular function.

Binds sGC at the stimulator site
Stimulates sGC and sensitizes it to nitric oxide
cGMP rises in vessels and heart
Vessels relax; fewer deaths and HF admissions

Indications

Symptomatic chronic heart failure with reduced ejection fraction after a recent worsening event (hospitalization or outpatient IV diuretics), to reduce cardiovascular death and heart failure hospitalization Heart failure →

Adverse effects

Common

Low blood pressure
Dizziness and lightheadedness
Anaemia (pale skin, tiredness, breathlessness)

Contraindications

Pregnancy
Use with another sGC stimulator (riociguat)

Key interactions

Riociguat: Two sGC stimulators together; contraindicated.
Other vasodilators and antihypertensives: Additive fall in blood pressure.

What is monitored

Blood pressure, especially when the dose is raised
Haemoglobin
Pregnancy test before starting in people who could become pregnant
Heart failure symptoms and weight

Administration and safety

Oral tablet, once a day with food; may be crushed and mixed with water just before use.
Started low and increased about every two weeks as blood pressure allows.
Not combined with riociguat.

Pregnancy and breastfeeding

Contraindicated: it may harm the fetus; a negative pregnancy test is required before starting and reliable contraception during treatment and for a month after.

Nursing care

Before: blood pressure, haemoglobin, pregnancy test, current medicines (riociguat).
During: blood pressure, dizziness, signs of anaemia.
Teach to rise slowly and to report fainting.
Teach reliable contraception and not to breastfeed.

Pharmacokinetics

Absorption: Oral, taken with food.
Half-life: Longer than riociguat's, allowing once-daily use (G&G).

Test yourself

Think of the answer, then tap the question to see it.

In which patients is vericiguat used?

Symptomatic heart failure with reduced ejection fraction after a recent worsening (hospitalization or IV diuretics), on top of standard therapy.

How does vericiguat differ from riociguat?

Same mechanism (sGC stimulator), but a longer half-life and use in heart failure rather than pulmonary hypertension.

Which drug must never be combined with vericiguat?

Riociguat (another sGC stimulator).

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Connections

← Back to the class: Soluble guanylate cyclase (sGC) stimulators

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Vericiguat: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); Structure of huamn soluble guanylate cyclase in the riociguat and NO-bound state (RCSB Protein Data Bank, 2021); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.